Don’t Blame Heritage for ObamaCare Mandate

Is the individual mandate at the heart of “ObamaCare” a conservative idea? Is it constitutional? And was it invented at The Heritage Foundation? In a word, no.

The U.S. Supreme Court will put the middle issue to rest. The answers to the first and last can come from me. After all, I headed Heritage’s health work for 30 years. And make no mistake: Heritage and I actively oppose the individual mandate, including in an amicus brief filed in the 11th Circuit Court of Appeals to the Supreme Court.

Nevertheless, the myth persists. ObamaCare “adopts the ‘individual mandate’ concept from the conservative Heritage Foundation,” Jonathan Alter wrote recently in The Washington Post. MSNBC’s Chris Matthews makes the same claim, asserting that Republican support of a mandate “has its roots in a proposal by the conservative Heritage Foundation.” Former House speaker Nancy Pelosi and others have made similar claims.

The confusion arises from the fact that 20 years ago, I held the view that as a technical matter, some form of requirement to purchase insurance was needed in a near-universal insurance market to avoid massive instability through “adverse selection” (insurers avoiding bad risks and healthy people declining coverage). At that time, President Clinton was proposing a universal health care plan, and Heritage and I devised a viable alternative.

My view was shared at the time by many conservative experts, including American Enterprise Institute (AEI) scholars, as well as most non-conservative analysts. Even libertarian-conservative icon Milton Friedman, in a 1991 Wall Street Journal article, advocated replacing Medicare and Medicaid “with a requirement that every U.S. family unit have a major medical insurance policy.”

My idea was hardly new. Heritage did not invent the individual mandate.

But the version of the health insurance mandate Heritage and I supported in the 1990s had three critical features. First, it was not primarily intended to push people to obtain protection for their own good, but to protect others. Like auto damage liability insurance required in most states, our requirement focused on “catastrophic” costs — so hospitals and taxpayers would not have to foot the bill for the expensive illness or accident of someone who did not buy insurance.

Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick.

And third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement.

Stuart M. Butler has guided The Heritage Foundation's domestic policy research for more than 30 years. As Vice President of Domestic and Economic Policy Studies, Butler's steady hand has helped shape the debate on critical issues from health care and Social Security to welfare reform and tax relief.

Join The Discussion

Certainly, it would be wrong and counterproductive to force individuals to buy coverage in today's fragmented and overly-expensive health insurance market. But the Massachusetts plan fundamentally changes the existing market, partially deregulating it to make coverage more affordable while providing subsidies to ensure low-income residents can afford coverage.

Rather than focus on the bill's politically galvanizing "mandates," policymakers and pundits should step back and look at the big picture of this landmark reform.

Heritage seems to be trying to confuse again. I ask these blog readers to do a search on heritage.org for 'individual mandate' or 'personal responsibility' – particularly for pieces in 2006 – and you will find at least 10 pieces where Heritage is defending the individual mandate in Romneycare. I've printed them all out and you will see lines such as this: 'Furthermore, to allow people to go without health insurance, and then when they do fall ill expect someone else to pay the tab for their treatment is a de facto mandate on providers and taxpayers. Romney proposes to take that option off the table, leaving only two choices: Either buy insurance or pay for your own care. Not an unreasonable position, and one that is clearly consistent with conservative values."

You can replace Romneycare with Obamacare and you hear the same argumetns today for Obamacare that Heritage made for MA health reform.

The problem is that this posting was meant for the folks opposing the bill so the 5+ negatives are the people who aren't really reading the reply. Thats how segmented the country is right now where it doesn't matter what the facts are, you twist a word or point a finger and immediately it becomes an "Us" against "them" issue rather than a problem for America.

What I find absolutely funny about the post is that it does nothing to refute that the mandate came from the foundation's view… His 3 key rally points are just contorted speech to try and push any negativity on Obama and not that this mandate actually had roots from somewhere else (like Heritage and Romneycare). Like this:

Point 1: "First, it was not primarily intended to push people to obtain protection for their own good, but to protect others." So… Obama's plan isn't going to protect others? Under the current statutes, if someone doesnt have healthcare, the hospital fits the bill, the taxpayers fit the bill, etc… If anything Obama's plan helps ease that tax burden and ensures people get the care they can afford.

Point 2: "Second, we sought to induce people to buy coverage primarily through the carrot of a generous health credit or voucher, financed in part by a fundamental reform of the tax treatment of health coverage, rather than by a stick." The voucher and financial piece was in the law and I believe parts of it still are — Republicans didn't want it in there… And I hardly call it a stick. You can NOT pay taxes and its on you to own it just like you can NOT have healthcare and pay a fine when you end up in the ER with no coverage.

Point 3: "third, in the legislation we helped craft that ultimately became a preferred alternative to ClintonCare, the “mandate” was actually the loss of certain tax breaks for those not choosing to buy coverage, not a legal requirement." I dont see why someone would not want to have affordable healthcare in the first place but in essence the "mandate" goes back to the first point, "Protecting others from the people who dont have healthcare"

Summary, its the same thing but its not Romneycare or Heritage Care or whatevercare, its Obama…

It's really funny to read some of these posts in early September now that the Supreme Court has ruled Obamneycare to be Constutitional. Most interesting is that the Court's view in allowing PPACA mirrors Stuart Bulter's point in the final paragragh that the taxing authority is the most important factor. In fact, despite Butler 's attempt to distance his ideas from PPACA, he fails to make any distinction at all since ObamneyCare meets all three of his criteria.

for anyone to blame any non government authority for what the American government decides to impose unconstitutionally on the people they govern, is the most egregious of all. think about that, won't we??!!!!

Every principled idea of America that promotes personal dignity with respects to all individuals' natural ability, using personal resources of faith, family, charities and church to carry out personal livelihoods proven beneficial for free people in society, the government converts into government control, complicating those private resources intentionally removing every bit of personal freedom and God given independence.

Thank you Heritage and all the like, who's ideas are written in respect of the founding principles and in respect of the people that catch on to live by what freedom involves as far as personal lives and government control goes!

Since when do conservatives support unconstitutional ideas because it seems to have good intentions. That's the big govt liberals' job. Many argue that Fdr's policies were done with good intentions but that is not an excuse for usurping the supreme law of the land. God bless the work of the heritage foundation but at least admit when your wrong.

Obama's distorting the words Jesus Christ. The Dems, the established Republicans (in the case Romney's lies against Newt), and the media are distorting the ture facts. What chance does the HF have against this deliberate attempt to rewrite history?

Charles Fried, Reagan's Solicitor General, sees the whole issue very clearly: "Is it within the power of Congress? Well, the power of Congress is to regulate interstate commerce. Is health care commerce among the states? Nobody except maybe Clarence Thomas doubts that. So health care is interstate commerce. Is this a regulation of it? Yes. End of story." See complete interview at: http://www.washingtonpost.com/blogs/ezra-klein/po…

1) This mandate too is intended to "protect others" and not "to force you into…" anything "… for your own good. By mandating that you buy insurance, it means that it will once again be possible for individuals to buy insurance outside of huge groups, because this ridiculous "pre-existing condition" and adverse selection hide-the-ball game will stop.

2) The carrot/stick distinction is nil. Raising taxes overall and then providing a "generous health credit or voucher" instead of a "stick" is exactly the same in principle and effect of simply having a penalty for not being insured. I'm quite certain you know this, and your dissembling on this point only weakens your other arguments.

3) Your third point is your second point rephrased. It makes no more sense the second time. Failing to give someone a tax break if they don't do something is exactly the same in force, effect, intent, economics, and in all other ways as giving them a tax penalty if they don't do that thing. Exactly. You know it, I know it, everyone in this debate knows it, and it only makes you look childish and ridiculous to deny it.

Don’t have time to read the Washington Post or New York Times? Then get The Morning Bell, an early morning edition of the day’s most important political news, conservative commentary and original reporting from a team committed to following the truth no matter where it leads.

Email address

Ever feel like the only difference between the New York Times and Washington Post is the name? We do. Try the Morning Bell and get the day’s most important news and commentary from a team committed to the truth in formats that respect your time…and your intelligence.